La función tiroidea en pacientes con enfermedades autoinmunes / Thyroid function in patients with autoimmune diseases

Introducción: la aparición de enfermedad tiroidea autoinmune presenta una gran prevalencia en pacientes con diagnósticos de enfermedades autoinmunes. Objetivo: describir las enfermedades tiroideas autoinmunes en pacientes con enfermedades autoinmunes, atendidos en el Hospital Pediátrico William Soler Ledea, del 1ro. de octubre de 2014 al 31 de enero de 2017. Métodos: estudio descriptivo, transversal y prospectivo en 42 pacientes con diagnóstico de enfermedad autoinmune. Se midieron variables demográficas, enfermedad autoinmune (lupus eritematoso sistémico, hepatitis autoinmune, artritis idiopática juvenil y esclerodermia), función tiroidea (eutiroidismo, hipotiroidismo e hipertiroidismo) y anticuerpos antitiroideos (antiperoxidasa y antitiroglobulina). Resultados: las enfermedades autoinmunes, con enfermedad tiroidea, se presentaron en 26,2 por ciento (n= 11): con hipotiroidismo 81,8 por ciento (n= 9) y con hipertiroidismo 18,2 por ciento (n= 2). El hipotiroidismo estuvo presente en adolescentes del sexo femenino (n= 7), el lupus eritematoso sistémico en el 88,9 por ciento (n= 8), seguido de esclerodermia en el 11,1 por ciento (n= 1). El hipertiroidismo solo se diagnosticó en el lupus eritematoso sistémico 100 por ciento (n= 2), ambas en adolescentes del sexo femenino. Solo 3 pacientes tuvieron anticuerpos antitiroideos positivos, solo 2 se correspondieron con enfermedad tiroidea autoinmune: hipotiroidismo con anticuerpos antitiroideos positivos 22,2 por ciento (n= 2, en este caso correspondiente al lupus eritematoso sistémico). Los pacientes sin enfermedad tiroidea (73,8 por ciento; n= 31), a su vez, predominaron en edades de 10-14 años (n= 15; 48,4 por ciento) y en el sexo femenino (n= 22; 71,0 por ciento). Conclusión: el hipotiroidismo es más frecuente en adolescentes femeninas, con diagnóstico de lupus eritematoso sistémico, y con evidencia de anticuerpos antitiroideos positivos(AU)

Introduction: the appearance of autoimmune thyroid disease has high prevalence in patients diagnosed with autoimmune diseases. Objective: to describe the autoimmune thyroid diseases in patients with autoimmune diseases attended at William Soler Ledea Pediatric Hospital from October 1, 2014 to January 31, 2017. Methods: descriptive, cross-sectional and prospective study in 42 patients diagnosed with autoimmune disease. Demographic variables, autoimmune disease (systemic lupus erythematosus, autoimmune hepatitis, juvenile idiopathic arthritis and scleroderma), thyroid function (euthyroidism, hypothyroidism and hyperthyroidism) and antithyroid antibodies (antiperoxidase and antithyroglobulin) were measured. Results: autoimmune diseases with thyroid disease occurred in 26.2 percent (n= 11), with hypothyroidism 81.8 percent (n= 9), and with hyperthyroidism 18.2 percent (n= 2). Hypothyroidism was present in female adolescents (n= 7), systemic erythematosus lupus in 88.9 percent (n= 8) followed by scleroderma in 11.1 percent (n= 1). Hyperthyroidism was only diagnosed 100 percent in systemic erythematosus lupus (n= 2), both in female adolescents. Only 3 patients had positive antithyroid antibodies, only 2 corresponded to autoimmune thyroid disease: hypothyroidism with positive antithyroid antibodies with 22.2 percent (n= 2, in this case corresponding to systemic lupus erythematosus). Patients without thyroid disease (73.8 percent; n= 31) predominated at ages from 10 to 14 years old (n= 15; 48.4 percent) and in females (n= 22; 71.0 percent). Conclusion: hypothyroidism is more frequent in female adolescents, with a diagnosis of systemic erythematosus lupus, and with evidence of positive antithyroid antibodies(AU)

Association between the clinical severity of oral lichen planus and anti-TPO level in thyroid patients

Abstract This study considered a possible relationship between the severity of oral lichen planus (OLP), serum anti-TPO autoantibodies (TPOAb) titer and thyroid disease in OLP patients. Forty-six OLP patients with positive TPOAb results (> 35 IU/ml) who had also been diagnosed with thyroid disease were included in the study group. The control group consisted of 46OLP patients with no thyroid disease. The study and control groups (92) were divided to two subgroups of erosive OLP (EOLP) and non-erosive OLP (NEOLP). Serum TPOAb levels and IL-8 (to measure OLP severity) were evaluated using the independent t-test, chi-square and conditional logistic regression analysis (α = 0.05). A significant positive correlation was found between serum IL-8 and TPOAb levels in the study group (r = 0.783; p = 0.001). The positive blood levels of TPOAb were significantly associated with an increased risk of EOLP (OR = 4.02 at 95%CI; 1.21–13.4; p = 0.023). It is possible to used positive serum TPOAb levels in patients with OLP as in indicator of possible undetected thyroid disorders in those patients. Because erosive OLP has been associated with TPOAb in thyroid patients, it may be useful to determine TPOAb levels of such patients to diagnose a possible undetected thyroid disorders and follow-up for malignancy.

Evaluation of thyroid function and autoimmunity in HIV-infected women / Avaliação da função tiroidiana e autoimunidade em mulheres infectadas pelo HIV

Autoimmune thyroid diseases (AITD) are the main causes of thyroid dysfunction and the most common autoimmune diseases in the world. An association between AITD and infections with the human immunodeficiency virus (HIV), in combination with the effects of highly active anti-retroviral therapy (HAART), has been suggested by several research groups. The aim of the present study was to evaluate the frequency of thyroid dysfunction and AITD in women > 35 years of age infected with HIV, and to identify factors associated with the emergence of these thyroid abnormalities. HIV-infected women (n = 153) selected from the infectious disease outpatient clinic at a University Hospital in Rio de Janeiro were characterized based on their circulating CD4+ lymphocytes levels, viral loads, serum TSH levels, and the presence of FT4 and anti-thyroperoxidase antibodies (TPO-Ab). A total of 129 participants were on HAART and 24 were not. The frequency of thyroid disorders was 7.8% (12/153 patients) and all were on HAART at the time of diagnosis, yielding a prevalence of 9.3% in patients receiving HAART compared with 0% in patients not on HAART. AITD, hyper, and hypothyroidism were detected in 4.6%, 3.1%, and 4.1% of HAART patients. It was not detected any thyroid dysfunction or autoimmunity in HIV-infected women not on HAART. This study demonstrated an association between HAART and the development of AITD. In addition AITD only developed in HAART patients also presenting with undetectable viral loads and slightly elevated CD4+ T cell counts.

Doenças tiroidianas autoimunes (DTAI) são a maior causa de disfunção tiroidiana e são as doenças autoimunes mais comuns no mundo. A associação entre DTAI e infecções com o vírus da imunodeficiência humana (HIV), em combinação com a terapia antirretroviral altamente ativa (HAART), foi sugerida por vários grupos de pesquisadores. O objetivo do presente estudo foi avaliar a fre-quência de disfunção tiroidiana e DTAI em mulheres com mais 35 anos de idade infectadas com o HIV e identificar fatores associados com a emergência dessas anormalidades tiroidianas. As mulheres infectadas com HIV (n = 153), selecionadas do ambulatório de doenças infecciosas de um hospital universitário do Rio de Janeiro, foram caracterizadas com base no nível de linfócitos CD4+ circulantes, carga viral, níveis de TSH sérico e presença de anticorpos FT4 e antitiroperoxidase (TPO-Ab). Um total de 129 participantes se tratava com HAART e 24 não. A frequência de desordens da tiroide foi 7,8% (12/153 pacientes) e todas estavam em tratamento com HAART no momento do diagnóstico, levando a uma prevalência 9,3% em pacientes recebendo HAART, em comparação com 0% em pacientes não tratadas com HAART. DTAI, hipertireoidismo e hipotireoidismo foram detectados em 4,6%, 3,1% e 4,1% das pacientes tratadas com HAART. Não foram detectadas disfunção tiroidiana ou autoimunidade em mulheres infectadas com HIV e não tratadas com HAART. Este estudo demonstrou uma associação entre a HAART e o desenvolvimento de DTAI. Além disso, a DTAI apenas se desenvolveu em pacientes tratadas com HAART e que apresentavam cargas virais indetectáveis e contagens de células CD4+ T levemente elevadas.

Alta frecuencia de patología tiroidea funcional y autoinmune en mujeres embarazadas chilenas catalogadas como sanas / High frequency of functional and autoimmune thyroid disease in women classified as healthy Chilean pregnant

Background: Untreated functional thyroid diseases are a risk factor for maternal and fetal complications during pregnancy. Aim: To determine the frequency of functional or autoimmune thyroid disease in healthy women during the first trimester of pregnancy. Subjets and Methods: healthy pregnant women attending a routine consult during their first trimester of pregnancy were studied. Thyroid stimulating hormone (TSH), total and free thyroxin (T4) anti-thyroid peroxidase (TPO) antibodies and spot urine iodine levels were measured. The reference ranges provided by the Atlanta Georgia Consensus in 2004 were used as normal values. A urine iodine concentration < 150 ug/L was considered low. Results: One hundred women age 30 +/- 5 years with a mean gestational age of 8,8 +/- 1,9 weeks, were studied. The frequencies of subclinical hypothyroidism, clinical hypothyroidism, isolated low thyroxin lecels, high antiTPO antibodies and low urine iodine levels were 19, 2, 3, 13 and 15 percent, respectively. Women with high TSH levels had lower total and free T4 levels. Conclusions: Twenty one percent of this sample of apparently healthy pregnant women had a clinical or subclinical hypothyroidism.

Características clínicas, perfil hormonal y marcadores de autoinmunidad de pacientes con enfermedad de Graves / Clinical characteristics, thyroid function profile and autoimmune markers in patients with Graves' disease

Objetivo: Describir las características clínicas, el perfil hormonal y los marcadores de autoinmunidad de pacientes con enfermedad de Graves (EG), atendidos en el servicio de endocrinología de un hospital general. Material y métodos: Estudio descriptivo, retrospectivo de pacientes con diagnóstico de EG atendidos en el servicio de endocrinología del HospitalNacional Cayetano Heredia durante el año 2005. Los pacientes fueron identificados utilizando el Registro Diario de Atención y Otras Actividades del consultorio externo. Para el análisis estadístico se utilizó el programa SPSS versión 12,0. Resultados: Se revisaron 111 historias clínicas. La edad promedio fue de 40,6 ± 14 años. El 71,2% eran mujeres. El 20,7% tenía antecedentefamiliar de otra enfermedad autoinmune. El tiempo de enfermedad promedio antes de la consulta fue 18,9 ± 30,4 meses. Los síntomas más frecuentes fueron: tremor, piel delgada, palpitaciones y baja de peso. El peso promedio de la glándula tiroides estimado por palpación fue 69 ± 27,5 gr, 38,7% presentaba exoftalmos y 18,9% mixedema pretibial. El perfil hormonal mostró TSH suprimida, T4 libre y T3 total elevados. El 86,7% de los casos tenía autoanticuerpos anti-peroxidasa tiroidea (anti-TPO) positivo. En 95,5% el tratamiento incluyó el uso de tionamidas. El análisis bivariado mostró que las mujeres tuvieron antecedente familiar de enfermedad tiroidea autoinmune en mayor frecuencia que los varones (27,8 vs. 9,4%) (p=0,04). Conclusión: La población estudiada con EG fueron con mayor frecuencia mujeres entre la tercera y sexta década de la vida.El peso estimado de la glándula tiroides fue tres veces lo normal, con alta frecuencia de oftalmopatía y mixedema. La mayoría tiene marcadores humorales de autoinmunidad y el tratamiento inicial se basa en el uso de tionamidas.

Objective: To describe the clinical characteristics, thyroid function profile and autoimmune markers in patients with Graves’ disease (GD) treated at the endocrine service of a general hospital. Material and methods: Descriptive and retrospective study in patients with GD treated at the Hospital Nacional Cayetano Heredia during 2005, identified in the Daily Registry of Attention and Other Activities of the Endocrine Service. For statistical analysis, SPSS software was used. Results: We reviewed 111 medical charts. The mean age was 40.6 ± 14 years. 71.2% were women. Twenty three patients (20.7%) reported familial history of autoinmune disease. The mean time of disease was 18.9 ± 30.4 months before diagnosis. The most frequent symptoms were: tremor, thin skin, palpitations and weight loss. The mean thyroid weight was 69 ± 27.5 grams. In 38.7% exophthalmos was present and 18.9% had myxedema. Hormonal profile showed suppressed TSH, elevated levels of free T4 and total T3. In 86.7% autoantibodies against thyroid peroxidase (anti-TPO) were positive. The initial treatment included thionamides in 95.5% of patients. Further statistical analysis showed that women had more frequent familiar history of autoinmune thyroid disease than men (27.8% vs. 9.4%) (p = 0.04). Conclusions: Most of our patients with GD were women between third and sixth decade of life. The estimated weight of the thyroid gland was three times the normal weight and ophthalmopathy and myxedema were frequent. Most of our patients had positive autoimmune markers and theinitial treatment included thionamides.

Enfermedad tiroidea autoinmune: estudio clínico epidemiológico / Autoimmune thyroid disease: clinical-epidemiology study

Este estudio prospectivo sobre los aspectos clínico-epidemiológicos de la enfermedad tiroidea autoinmune en una muestra venezolana de 1000 pacientes, estableció en 9,9 % la prevalencia de enfermedad tiroidea; a su vez, la enfermedad tiroidea autoinmune fue la enfermedad tiroidea más común con una frecuencia relativa de 42% de todos los casos de enfermedad tiroidea y una prevalencia de 4,2%. Se observaron 42 casos de enfermedad tiroidea autoinmune: 27 de tiroiditis crónica autoinmune, 4 de tiroiditis silente y postpartum, uno de hipertiroidismo inducido por amiodarona y 11 de enfermedad de Graves. Una anciana con tiroiditis crónica autoinmune había presentado enfermedad de Graves 40 años antes, siendo esta una posibilidad evolutiva de la enfermedad tiroidea autoinmune. La enfermedad tiroidea fue más frecuente en las mujeres, especialmente en las tiroiditis autoinmunes, cuya relación hembra: varón fue 9,7: 1. Las hembras que constituyeron el 55 % de los 1000 casos, resultaron el 88% de los casos de enfermedad tiroidea autoinmune, diferencia también encontrada entre las ancianas de ambas muestras. En los mil pacientes, una de cada 22 mujeres presentó tiroiditis crónica autoinmune, clínica o subclínica. En los casos de enfermedad tiroidea autoinmune, 40% refirió enfermedad tiroidea familiar, particularmente autoinmune, 3 casos tenían historia familiar de enfermedad autoinmune sistémica y 17% se asoció con otra enfermedad autoinmune endocrina o sistémica. La positividad de los anticuerpos antitiroideos séricos, prueba suficiente para el diagnóstico de tiroiditis crónica autoinmune, se encontró en 89% de nuestros casos. El hipotiroidismo permanente es la secuela funcional más importante de tiroiditis crónica autoinmune, especialmente en las ancianas, tal como ocurrió en 55,5 % de 27 casos, 22,2 % como hipotiroidismo clínico y 33,3% como hipotiroidismo subclínico. En 12 casos con función tiroidea normal el promedio de la edad fue 46,75 ± 17,06. años...

This prospective clinical-epidemiologic study about autoimmune thyroid disease, in a Venezuelan sample of 1000 patients, established in 9.9% the prevalence of thyroid diseases; autoimmune thyroid disease was the most common thyroid disease with a relative frequency of 42% of all thyroid diseases cases and with prevalence of 4.2%. Forty two cases of autoimmune thyroid disease were observed: 27 with chronic autoimmune thyroiditis, 4 with silent and postpartum thyroiditis, one with amiodarone-induce thyrotoxicosis and 11 with Graves’ disease. One female initially with Graves’ disease was observed after 40 years with chronic autoimmune thyroiditis, an alternative in autoimmune thyroid disease evolution. In our study, all thyroid diseases were more frequent in women, especially in autoimmune thyroiditis, which female: male ratio was 9.7: 1. Females that represented 55% of 1000 cases were 88% of autoimmune thyroid disease cases, and this difference was found also between elderly females of both samples. In the 1000 patients, one of each 22 females presented clinical or subclinical chronic autoimmune thyroiditis. Forty percent of autoimmune thyroid disease cases referred familiar thyroid disease, particularly autoimmune, 3 cases had family history of systemic autoimmune disease and 17% was associated with other autoimmune endocrine or systemic disease. Antithyroid antibody confirmation is sufficient proof for diagnosis, as was observed in 89% of our cases. Permanent hypothyroidism is the most important functional consequence of chronic autoimmune thyroiditis, especially in older females, such as occurred in 55.5% of 27 cases, 22.2% as clinic hypothyroidism and 33.3% as subclinic hypothyroidism. In 12 cases with normal thyroid function the mean age was 46.75 ± 17,06 years, in 9 cases of subclinical hypothyroidism was 49,00 ± 18,97 years and in 6 cases of clinical hypothyroidism 53,50 ± 20,57 years. In chronic autoimmune thyroiditis, this progressive decline...

Frequency Of Pancreatic Beta-Cell Autoimmunity Markers In Patients With Autoimmune Thyroid Disease / Frecuencia de marcadores de autoinmunidad beta pancreática en pacientes con enfermedad tiroidea autoinmune

A total of 305 ambulatory patients recruited at the Division of Endocrinology, Hospital de Clínicas, University of Buenos Aires, with autoimmune thyroid disease (AITD) were studied to search for associations between autoimmune thyroid disease and presence of serum markers of autoimmune diabetes mellitus. Screening for markers of pancreatic beta-cell autoimmunity was performed by radioligand binding assays (RBA) as follows: autoantibodies to glutamic acid decarboxylase (GADA) and proinsulin (PAA) were determined in all sera, whereas autoantibodies to protein tyrosine phosphatase (IA-2A) and insulin (IAA) were additionally measured in 200 sera randomly selected from the total collection. In addition, every GADA positive serum among the remaining 105 sera was systematically tested for the presence of IA-2A and IAA. In the cohort of 305 AITD patients 22 (7.2%) were previously diagnosed as type 1, type 2 or insulin-requiring type 2 diabetics. Ten of these patients presented serum marker positivity specific for β-cell autoantigens and 12 were marker negative. On the other hand, considering the majority of non-diabetic AITD patients (n=283), β-cell marker positivity was detected in 17 individuals (6.0%). The prevalence of autoimmune diabetes markers was much higher in the studied population than in the general population utilized as a control group, and GADA was the most frequent marker.

Se investigó la asociación entre enfermedad tiroidea autoinmune y la presencia de marcadores séricos de diabetes mellitus en 305 pacientes ambulatorios con enfermedad tiroidea autoinmune reclutados en la División Endocrinología. La búsqueda de marcadores de autoinmunidad contra las células beta pancreáticas se realizó por la técnica de unión de radioligandos (RBA) como se detalla a continuación: se determinaron autoanticuerpos contra la decarboxilasa del ácido glutámico (GADA) y proinsulina (PAA) en todos los sueros, mientras que los anticuerpos contra la proteína tirosina fosfatasa (IA-2A) e insulina (IAA) fueron medidos en 200 de estos sueros tomados al azar de la colección total. Además, en los restantes 105 pacientes, la presencia de IA-2A y IAA fue evaluada en todos los sueros positivos para GADA. Del grupo de 305 pacientes con enfermedad tiroidea autoinmune 22 (7.2%) fueron diagnosticados previamente como diabéticos tipo 1, tipo 2 o tipo 2 insulino-requirientes. Diez de ellos presentaron positividad para marcadores específicos de autoantígenos de célula β, en tanto 12 fueron negativos. Por otra parte, en 17 de los 283 pacientes (6.0%) con enfermedad tiroidea autoimmune y sin diagnóstico previo de diabetes, se detectó positividad para marcadores de célula β. La prevalencia de marcadores de autoinmunidad asociados a diabetes fue mayor en la población estudiada que en la población general usada como grupo control, siendo GADA el marcador más frecuente.

Associação entre marcadores sorológicos de doença celíaca e das doenças autoimunes da tireóide / Association between serum markers for celiac and thyroid autoimmune diseases

Doença celíaca (DC) é uma doença autoimune do intestino delgado com importante associação com HLA-DQ2 e DQ8. Tem o glúten como fator etiológico e a enzima transglutaminase (TGase) tecidual como autoantígeno. A DC é associada a outras doenças autoimunes como diabetes mellitus tipo 1, lupus eritematoso sistêmico, artrite reumatóide, síndrome de Sjõgren e doenças autoimunes da tireóide. O objetivo deste estudo foi investigar a ocorrência de anticorpos séricos da classe IgA anti-endomísio e anti-TGase tecidual humana em indivíduos com anticorpo anti-tireoidiano (AAT) positivo. Foi também pesquisada a concordância destes dois marcadores. Anticorpos anti-endomísio foram positivos em 10 de 456 (2,2 por cento) e anti-TGase tecidual foi positiva em 14 de 454 (3,1 por cento) dos indivíduos com AAT positivo. No grupo controle, 1 de 197 (0,5 por cento) e 2 de 198 (1 por cento) foram positivos para anticorpo anti-endomísio e anti-TGase tecidual humana, respectivamente. A chance de positividade dos anticorpos anti-endomísio foi de 4,42 e do anti-TGase tecidual humana 3,12 vezes maior nos indivíduos com positividade para AAT que nos controles. Um elevado índice de concordância (k= 0,84) foi obtido entre os testes para anticorpos anti-endomísio e anti-TGase. Os resultados obtidos neste trabalho não justificam uma triagem rotineira de DC em portadores de AAT. Concluímos que a pesquisa de anticorpos anti-TGase mostrou-se um teste útil para rastrear DC.

Glutamic acid decarboxylase [GAD65] and thyroid autoantibodies in Omani patients with type 2 diabetes

Autoimmunity is a common feature in type 1 diabetes mellitus [DM]. Little is known of the role of autoimmunity in type 2 diabetes. Antibodies to glutamic acid decarboxylase [GAD65] and thyroid antigens have been reported with various frequencies in diabetic patients. In this study, we investigated the prevalence and association of antibodies to GAD65, anti-thyroglobulin [A-TG-A], anti-thyroid microsomal [ATMA] antibodies, haemoglobin A[1c] [HbA[1c]] and fasting serum C-peptide in Omani patients with type 2 diabetes mellitus. We studied 100 Omani patients with type 2 diabetes for the presence of serum antibodies to GAD65, A-TG-A and ATMA by the use of commercially available kits. Results were compared with those from fifty patients with type 1 diabetes mellitus [DM] and fifty unaffected individuals who were used as controls. Results showed that type 2 DM had significantly high positivity levels [24%] of anti-GAD65 antibodies than the control group [4% - p < 0.05] though less than that found in type 1 DM [38%]. GAD65 antibodies were more commonly found in older females [> 40 years] with type 2 diabetes [p < 0.05]. A higher prevalence of ATMA was noted in both type 2 and type 1 diabetes [20 and 26% respectively] compared to the levels in the control group [8%]. There was a low prevalence and little difference in A-TG-A values among the three groups studied [9%, 14% and 4%]. Both A-TG-A and ATMA were more often expressed in older females with type 2 diabetes. HbA[1c] did not differ between groups with the duration of disease less or more than three years. When the same groups were tested for fasting serum C-pepticle, those with disease of more than three years duration had significantly higher prevalence [p < 0.05] as compared to those less than three years. This study confirms the presence and association of thyroid and GAD65 antibodies in some Omani patients with clinical diagnosis of type 2 DM

Presença de auto-anticorpos não-tireóide-específicos no soro de pacientes com hipotireoidismo auto-imune / Presence of nonthyroid-specific autoantibodies in autoimmune hypothyroidism

Auto-anticorpos contra componentes não-específicos da tireóide foram encontrados no soro de pacientes com doença auto-imune da tireóide. Neste estudo avaliamos a presença de auto-anticorpos antinucleares (ANA), antimitocôndria (anti-MC) no soro de pacientes com hipotireoidismo auto-imune (HA), comparando-os a controles saudáveis. Estudamos 70 pacientes com hipotireoidismo auto-imune (tireoidite de Hashimoto ou tireoidite atrófica) e 70 controles saudáveis (sem diagnóstico de doença auto-imune e tireoidiana), todos do sexo feminino, com média de idade de 50,2 anos (+ 15,9) e 49,6 anos (+ 14,4), respectivamente. O ANA, detectado através do sistema Inno-LIA ANA (Innogenetics, Bélgica), foi positivo em 26 por cento dos pacientes com HA e em 14 por cento dos controles, não sendo esta diferença significativa (p = 0,09). Não houve diferença entre tempo de doença ou idade entre os grupos ANA positivo ou negativo. Anticorpos anti-ML e anti-Mc foram negativos em todas as amostras, sendo analisados através de imunofluorescência indireta. Concluímos que pacientes com hipotireoidismo auto-imune não apresentaram maior incidência de auto-anticorpos não-específicos para tireóide do que controles saudáveis. Ressaltamos, contudo, que a associação entre doenças auto-imunes da tireóide e outras doenças auto-imunes é fato incontestável, podendo ocorrer em qualquer período no curso de sua evolução. Portanto avaliações regulares são recomendadas.

Thyroid function in Kuwaiti subjects with Down's syndrome

To investigate the thyroid function of individuals with Down's syndrome [DS]. Thyroid function and antithyroid antibodies were measured in 58 Kuwaitis with DS who resided at a residential facility or attended rehabilitation centers. Twenty-six subjects [45%] were euthyroid and 32 [55%] had thyroid dysfunction. One patient had previously been diagnosed with thyroid failure whereas the other 31 patients had newly discovered disease: 9 patients had primary hypothyroidism [T4 9.95 +/- 1.1 pmol/l and TSH 15.15 +/- 11.93 mU/l], 19 subclinical hypothyroidism [TSH 6.47 +/- 2.57 mU/l], 1 secondary hypothyroidism, 1 hyperthyroidism, and the remaining 1 subclinical hyperthyroidism. Antithyroid antibodies were found in 52% of the total subjects and in 59% of those with thyroid dysfunction. Conclusions: Thyroid dysfunction is common in Kuwaiti subjects with DS and is presumably the consequence of autoimmune thyroid disease. Periodic thyroid function testing is recommended in individuals with DS, which is best done through a national program

Autoimmune and non-autoimmune thyroid diseases have different patterns of cellular HLA class II expression

CONTEXT: Surface HLA-DR antigen is usually only expressed by antigen-presenting cells (APC). In autoimmune thyroid disease, follicle cells function as APC, thus expressing HLA-DR. However, non-autoimmune thyroid diseases may also express surface class II antigens. OBJECTIVE: To evaluate the presence and pattern of HLA class II expression in autoimmune and non-autoimmune thyroid disorders. DESIGN: Retrospective: histopathological and immunohistochemical analysis. LOCATION: Referral center, university hospital. SAMPLE: Ten histologically normal thyroids, 11 GravesÆ disease, 7 HashimotoÆs thyroiditis, 10 atoxic multinodular goiter and 3 toxic adenomas were analyzed by immunohistochemistry, using a monoclonal antibody anti-HLA-DR. MAIN MEASUREMENTS: The presence of these antigens in thyroid follicular cells and their relation to inflammatory infiltrate was evaluated. The pattern of HLA-DR expression in thyroid follicular cells was analyzed: membrane, cytoplasmic or both. RESULTS: Although HLA-DR antigens were sparsely present in one of the 8 normal thyroids, in 6 of the 9 atoxic multinodular goiter and in 2 of the 3 toxic adenomas a net positivity could be seen in large areas. In all 5 HashimotoÆs thyroiditis and in 7 of the 10 GravesÆ disease cases. This expression occurred in follicle cells either in contact with inflammatory cells or not. In non-autoimmune thyroid disease, HLA-DR positivity was essentially cytoplasmic, whereas in GravesÆ disease and Hashimoto thyroiditis it was mainly in cell membranes. CONCLUSIONS: It is suggested that the HLA class II expression on the surface of follicle cells could be related to auto-antigen presentation to the immune system by these cells, leading to inflammation

Prevalencia de anticuerpos antitiroglobulina y antimicrosomales en enfermedad tiroidea autoinmune / Antithyroglobulin and microsomal antibodies prevalence in autoimmune thyroid disease

Objetivo: Analizar la prevalencia de anticuerpos antitiroideos en enfermedades tiroideas, su relación con variables clínicas y epidemiológicas, y su utilidad diagnóstica. Métodos: Se determinaron anticuerpos antimicrosomales y antitiroglobulina por aglutinación de partículas de gelatina en 32 pacientes sanos (25 mujeres, 7 hombres) y 108 (92 mujeres, 16 hombres) con enfermedad tiroidea; diagnosticados por examen clínico, confirmados por laboratorio y cuando fue necesario por ecografía, pruebas de captación, biopsia y otras. Se consideró la patología, edad y sexo de los pacientes. Resultados: Las enfermedades tiroideas autoinmunitarias predominaron sobre las no autoinmunes en la población estudiada, 64,8 por ciento vs 35,2 por ciento. Los anticuerpos antimicrosomales fueron positivos en altos títulos en la mayoría de los pacientes con enfermedad de Graves y Hashimoto, mientras que pacientes con enfermedades tiroideas no autoinmune presentaron baja frecuencia. La prevalencia de anticuerpos anti tiroglobulina en enfermedades tiroideas autoinmunes fue significativamente menor a la de antimicrosomales, (44,3 por ciento vs 98,6 por ciento p<0,05). Aunque no fue estadísticamente significativo, se encontró cierta asociación entre enfermedades tiroideas autoinmunes y otros desórdenes autoinmunes (Enfermedad de Addison) y no autoinmunes (Diabetes mellitus tipo II). No hubo relación entre parotiditis previa y autoinmunidad tiroidea. Los anticuerpos antimicrosomales mostraron mayor sensibilidad que los antitiroglobulina (98,6 por ciento y 44,3 por ciento), con especificidad comparable (85,7 por ciento y 95,7 por ciento). Conclusiones: Debido a la mayor prevalencia y sensibilidad presentada por los anticuerpos antimocrosomales, el diagnóstico de tiroiditis autoinmune podría basarse en la valoración de dichos anticuerpos, con determinación de anticuerpos antitiroglobulina en casos especiales. Existen factores hereditarios involucrados en el desarrollo de enfermedades autoinmunes tiroideas

Demonstration of HLA-DR antigen in a wide variety of thyroid lesions using a monoclonal antibody

The expression of HLA-DR antigen was analyzed in formalin- fixed paraffin-embedded sections of 218 normal and abnormal thyroid specimens. The specimens were selected from the biopsies received at the Pathology Laboratory over a period of 5 years. Sections were stained by H and E and immunoperoxidase technique using Avidin Biotin Conjugate method for a monoclonal antibody, HLA-DR-chain. Positivity for HLA-DR was detected in all cases of thyroiditis, in 84% of Graves' disease and in 80.8% of papillary carcinoma. HLA-DR was found in thyroid epithelial cells, lymphocytes and in vascular endothelial cells. On the other hand, thyroid epithelial cells in all cases of normal thyroid, simple goitre, cretinism with goitre, thyroid adenomas, follicular and anaplastic carcinomas showed no reactivity for HLA-DR. These results indicated that epithelial cells from thyroids of patients with autoimmune diseases commonly express HLA-DR antigen. Also, the presence of HLA-DR antigen in most papillary thyroid carcinomas may be helpful diagnostically in cases of follicular variant of papillary carcinoma

Aspectos inmunológicos de los pacientes psicóticos / Immunological aspects of psychotic patients

En un estudio de pacientes con tiroideopatías en el Hospital Escuela de Tegucigalpa, se encontraron cuatro pacientes con psicosis y valores altos de anticuerpos antimicrosomales y antitiroglobulinas. En un estudio control la presencia de anticuerpos antitiroideos (ATT) esta asociada con alta incidencia de antecedentes familiares de enfermedades inmunológicas, tiroideas y mentales, especialmente esquizofrenia